A place to exercise ideas before writing about them with greater discipline.

Wednesday, March 30, 2011

Plato on Health Care

The greatest surprises in reading Plato arise when he takes on topics I had not expected he would address, often in discussions where those topics do not initially seem relevant. Health care is a good case in point. This shows up in “Laws,” of all places. Perhaps this was because this was the last of the dialogues he wrote, so his own health and mortality were likely on his mind. As usual, what I discovered turned out to be fascinating.

First of all there was the nature of how health care was practiced. Clearly, there were those among the free men who received training in the necessary arts. However, they usually had slaves. Physicians would then share their training with their slaves, so the slaves could act as assistants. Where things get interesting, however, is that the slaves did more than just assist their masters with their masters’ patients:

Now have you observed that, as there are slaves as well as free men among the patients of our communities, the slaves, to speak generally, are treated by slaves, who pay them a hurried visit, or receive them in dispensaries? A physician of this kind never gives a servant any account of his complaint, nor asks him for any; he gives him some empirical injunction with an air of finished knowledge, in the brusque fashion of a dictator, and then is off in hot haste to the next ailing servant—that is how he lightens his master’s medical labors for him. The free practitioner, who, for the most part, attends free men, treats their diseases by going into things thoroughly from the beginning in a scientific way, and takes the patient and his family into his confidence. Thus he learns something from the sufferers, and at the same time instructs the invalid to the best of his powers. He does not give his prescriptions until he has won the patient’s support, and when he has done so, he steadily aims at producing complete restoration to health by persuading the sufferer into compliance.

It should not be surprising that slaves received health care, since an unhealthy slave was clearly not of much use to his/her owner. What is fascinating, however, is that training slaves in the medical arts enabled a two-tiered system of health care. Slaves would be administered to by other slaves through a system that bears an uncanny resemblance to the way in which we have “industrialized” health care. Through these operations, the slaves would free up the time of their owners to deal with health care as the service it deserves to be, grounded in a rich foundation of communication between the health care provider and his patient.

The possible corollary is that the intervention of insurance as an industry is responsible for bringing this two-tiered system into our own culture. Those who need insurance the most, assuming they get it at all (even if they get it under a legal obligation to provide it), find themselves receiving the same industrialized health care given to Greek slaves. Only those with the wealth and power to afford otherwise receive “service-based” health care, because their wealth entitles them to it. In other words the economic division that has now divided our society so sharply has turned us into a society of a new class of slaves (a state of affairs that Spike Lee had observed during the interviews he conducted for his film about Katrina, When the Levees Broke).

If this is truly the way things are, then any debate about whether or not “under God” belongs in the Pledge of Allegiance is misplaced; the real debate should be about that final phrase, “with liberty and justice for all!”